Surveillance for unexplained infectious disease‐related deaths

Heartland Virus-Associated Death in Tennessee

“…Similar to reports from China, this case suggests that older adults or persons with co-morbidities might be at risk for more severe HRTV disease, but this needs to be validated with additional case finding and description. Finally, this case highlights the importance of autopsies for the detection and surveillance of emerging pathogens in unexplained deaths [18]. …”

Role of the Medical Examiner in Zika Virus and Other Emerging Infections

“…However, many types of nonviolent deaths, including unexplained deaths and sudden natural deaths, not only are of public health significance but also are required by statute in most jurisdictions to be investigated by ME/Cs. [3][4][5] Many of these deaths are due to infectious processes, often making the ME/C the first physician to identify fatal disease in a particular patient. The key role of ME/Cs in identifying emerging infectious diseases is particularly well illustrated in the recognition of hantavirus pulmonary syndrome in the southwestern United States.…”

“…8 Tissue and serum samples from medical examiner autopsies have been used for dengue surveillance in Puerto Rico, to identify deaths due to new variant Creutzfeldt-Jakob disease, to track pediatric influenzaassociated mortality, and to identify fatal cases of encephalitis due to emergent Nipah virus in Malaysia and Bangladesh. 4,8,9 Even in the context of diseases with wellestablished surveillance mechanisms, new cases are routinely identified at autopsy, and new information is provided to further elucidate already diagnosed infections. For example, new diagnoses of human immunodeficiency virus (HIV) have been routinely identified at autopsy in New York City, with 142 decedents in 5 years being first diagnosed with HIV at autopsy by the medical examiner.…”

“…12 Other developments recognizing the ME/C role in infectious disease surveillance, both naturally occurring and potentially bioterrorism related, include the implementation of medical examiner/ coroner-based surveillance systems for fatal infectious diseases (''Med-X''), the formation of infectious death disease review teams (IDDRTs) at ME/C offices, and federal funding to support this infrastructure. 2,4,5 The Med-X surveillance system allows ME/Cs to electronically flag deaths that may be due to unusual infections, based on surveillance systems and autopsy-based pathologic syndromes, with automatic electronic notification of the local health department and enhanced laboratory testing for organism-specific diagnoses. 5 IDDRTs, comprised of forensic pathologists, infectious disease specialists, public health practitioners, laboratorians, and other stakeholders, can then be convened to review deaths designated as Med-X cases, improving the detection and investigation of infectious disease deaths and cultivating better communication between ME/Cs and public health agencies.…”